From theory to action: Implementing the WSSD Global Initiative on children's environmental health indicators
Starting regional pilots
CEHI aims to start a series of pilots on each continent, and welcomes the contribution of the regional pilots that have already started in Africa, Europe, Latin America and the Caribbean, the Middle East, and North America (Annex 1). It is understood that not all regions can initiate such a pilot immediately. Regional pilots starting in 2004/2005 drew on experiences and first lessons learned through ongoing indicator efforts in other regions.
Box 1
The Council of the North American Commission for Environmental Cooperation (CEC) had previously identified four priority children’s environmental health concerns as the focus of collaboration among the three countries (Canada, Mexico and the United States), namely: (i) asthma and respiratory diseases, (ii) effects of lead and other toxic substances including pesticides, and (iii) water-borne diseases. A Steering Group was convened, comprised of environment and health officials from the three countries, and representatives of the partner institutions CEC, PAHO, WHO and the International Joint Commission's (IJC) Health Professionals Task Force.
As a first step, CEC commissioned a feasibility study that the Steering Group reviewed and used as a basis for developing a set of recommendations. The Council subsequently adopted the Steering Group’s recommendations and committed to providing the data, wherever possible, for an initial set of 12 indicators within the three broad priority areas. The active involvement of all parties through the Steering Group, and the policy-level commitment provided by the Council, were instrumental in getting the initiative underway.
Following are some key steps in the North American approach:
The report will serve as a basis for:
The key is to work towards acquiring enough reliable information to assess the condition for each of these four priority concerns by country. During the first stage, the CEC approach will exclusively use existing data and methodologies while building towards a core set of harmonized indicators for the United States, Canada and Mexico in the longer term.
The CEC implementation approach
Recognizing that different regions and countries have diverse sets of children’s environmental health problems due, for example, to climate, geology, level of industrialization, degree of urbanization, and sociodemographic characteristics, regional pilots are presumed to take on a fair degree of autonomy while contributing to global children’s environmental health reporting under a common framework.
The participation of three or more countries per region is desirable. It would be best if participating countries within a region agreed to a common set of priority areas for indicator collection. However, in emphasizing the needs of countries and an approach that aims to be decentralized as much as possible, we propose that WHO Regional and Country Offices, in close coordination with UNICEF and UNEP, assume responsibility for working with countries and partners actively involved at the regional and country level to design and implement pilot projects (Figure 1), once countries have volunteered to participate in a regional indicators pilot. Countries play a key role in each step of this process, from their commitment to participate in the effort to the implementation of indicator collection and reporting, to translating results into action to protect children’s environmental health. Establishing strong links with the public health systems in each country will be essential, as these are usually influential in relation to surveillance activities.
We propose a flexible approach that focuses on what is feasible in the short-term while working towards a common set of indicators based on high-quality data in the long-term. The ongoing CEC indicators effort in North America may serve as an example of such a multi-step “flexible, continuous improvement approach to implementation” 4(see Box 1). Its primary emphasis is on providing information relevant to children’s environmental health priorities rather than achieving comparable indicators immediately.
The children's environmental health indicators, developed by WHO at the global level, provide a solid basis for indicator development and collection. However, we encourage regions and countries to be selective in their reporting of these proposed indicators and, where necessary, to adjust existing indicators to respond better to their own needs and data collection systems.
The indicators made available through the regional pilots as well as data available through ongoing international surveys will form the basis for a global clearing house on children’s environmental health indicators to be hosted by WHO. In addition to providing a first glimpse at the state of children’s environmental health in different regions of the world, these pilots will play an essential role in testing and evaluating different options for information and data collection. Based on their regional experiences, difficulties encountered and lessons learned will be exchanged among the partners. These will ultimately determine the recommendations for (i) increasing the geographic scope of the regional efforts, (ii) improving data quality, (iii) working towards common monitoring objectives and (iv) providing indicators to support policy needs.
We envisage that the evaluation of data collection approaches and data quality will feed back into a process of continuous improvement. The Partnership will assist this process and encourage harmonization of indicator reporting. It also aims to integrate appropriate children’s environmental health indicators into ongoing reporting of child health indicators, e.g. by WHO’s Department of Child and Adolescent Health and Development, and into ongoing reporting of environmental indicators, e.g. by UNEP’s GEO Programme.
